Sharps disposal containers filled with thousands of used syringes at the Harm Reduction Action Center Nov. 03, 2017. The Harm Reduction Action Center helps injection drug users with education, empowerment, but the center also includes a program for users to exchange used needles for new needles.

Andy Cross, The Denver Post

Harm Reduction Action Center executive director Lisa Raville looks through paperwork at the desk where users come in to the center to exchange used syringes for new syringes Nov. 03, 2017.

Andy Cross, The Denver Post

Sharps disposal containers filled with thousands of used syringes at the Harm Reduction Action Center Nov. 03, 2017. The Harm Reduction Action Center helps injection drug users with education, empowerment, but also includes a program for users to exchange used needles for new needles.

Andy Cross, The Denver Post

Sharps disposal containers filled with thousands of used syringes at the Harm Reduction Action Center Nov. 03, 2017. The Harm Reduction Action Center helps injection drug users with education, empowerment, but also includes a program for users to exchange used needles for new needles.

Statistics are written on a poster in front of several Sharps disposal containers that are filled with used syringes at the Harm Reduction Action Center Nov. 03, 2017.

Andy Cross, The Denver Post

Sharps disposal containers are given to users to fill with used syringes to exchange at the Harm Reduction Action Center Nov. 03, 2017. The Harm Reduction Action Center helps injection drug users with education, empowerment, but also includes a program for users to exchange used needles for new needles.

Andy Cross, The Denver Post

Harm Reduction Action Center Syringe Access Director/Senior Health Educator Ruth Kanatser, center, talks with a program participant during a new HIV/HEP C class at the Harm Reduction Action Center Nov. 03, 2017. The Harm Reduction Action Center helps injection drug users with education, empowerment, but also includes a program for users to exchange used needles for new needles.

Andy Cross, The Denver Post

Xavier, 25, listens to others during an interview at Harm Reduction Action Center, a center that helps injection drug users with education, empowerment, which also includes a site to exchange dirty needles for new needles Nov. 02, 2017.

Andy Cross, The Denver Post

Alan listens to others during an interview at Harm Reduction Action Center, a center that helps injection drug users with education, empowerment, which also includes a site to exchange dirty needles for new needles Nov. 02, 2017.

In semi-private booths, each with a chair and a mirror, Denver heroin users could shoot up with clean needles, no threat of arrest and under the supervision of staff trained to jump in with a life-saving antidote in case of overdose.

It would look more like a medical clinic than a party lounge, with floors and furniture that workers could hose down in the event of vomit or blood spills. Staffers would hand out sterile needles and possibly distilled water, but clients would bring their own drugs to cook and inject.

It’s called a supervised injection site, and Denver is on a path to become one of the first U.S. cities to open one — although doing so would require action by the City Council, the state legislature and possibly the federal government.

Seattle and San Francisco, ahead of Denver in planning, are attempting to open the first sites in this country, although there are more than 100 around the world.

Cities in Canada, Australia and Europe with supervised injection sites have seen fewer overdose deaths, reduced public drug use and decreased dropped syringes. A review of 75 studies found the sites were not linked to increased drug use or crime.

In Denver, officials supportive of the idea want fewer used needles dropped in city parks and hidden in the vines along the Cherry Creek bike path. They want fewer people using drugs in alleys along 16th Street Mall and overdosing in public bathroom stalls.

In 2016, 174 people died of overdoses in Denver. Twenty of them died in a public park, alley or bathroom.

Michael Torpacka, who first tried heroin at age 13, looks for empty alleys and bathrooms around downtown Denver multiple times a day to get his fix. Now 37, he lives on the city’s streets. He rushes through the cooking to boil his heroin. He rushes through the injection. He’s always nervous someone will see him and call police.

“You’re scared and you don’t have time to get this done,” he said Thursday.

Torpacka predicted Denver would see fewer needles in parks and along the river — and have fewer people using bathroom stalls to get high — if the city were to open a supervised injection site.

The Denver City Council is intrigued, too. Council president Albus Brooks plans to lead a trip leaving Wednesday to Vancouver, British Columbia, to visit that city’s injection clinic, called InSite, which opened in 2003. It was the first in North America.

Laurent Vu The/AFP/Getty Images

The front door of the Insite supervised injection Center in Vancouver, Canada, on May 3, 2011.

Laurent Vu The/AFP/Getty Images

A client of the Insite supervised injection Center in Vancouver, Canada, collects her kit on May 3, 2011. With more 600 visits per day on average, Insite believes it has made advances in the fight against AIDS.

Laurent Vu The/AFP/Getty Images

Addicts inject themselves at the Insite supervised injection Center in Vancouver, Canada, on May 3, 2011. In a radius of 500 meters around the center, deaths by overdose dropped by 35 percent since the opening, according to a study published in the medical newspaper The Lancet.

Laurent Vu The/AFP/Getty Images

A client of the Insite supervised injection Center in Vancouver, Canada, prepares a dose of drug to inject on May 3, 2011. In a radius of 500 meters around the center, deaths by overdose dropped by 35 percent since the opening, according to a study published in the medical newspaper The Lancet.

Laurent Vu The/AFP/Getty Images

A client of the Insite supervised injection Center in Vancouver, Canada, injects himself on May 3, 2011. Insite believes it has made advances in the fight against AIDS.

Laurent Vu The/AFP/Getty Images

A client of the Insite supervised injection center in Vancouver, Canada, injects himself on May 3, 2011. In a radius of 500 meters around the center, deaths by overdose dropped by 35 percent since the opening, according to a study published in the medical newspaper The Lancet.

Laurent Vu The/AFP/Getty Images

A worker at the Insite supervised injection Center in Vancouver, Canada, arranges syringes to be used by addicts on May 3, 2011. The Canadian Supreme Court is to settle a conflict between the government's wishes to close the center and the center's success in fighting the spread of AIDS among drug addicts. In eight years of existence, and with more 600 visits per day on average, Insite believes it has made advances in the fight against AIDS.

The momentum behind a Denver site comes largely from Lisa Raville, executive director of the Harm Reduction Action Center, a treatment and counseling center. It provides users with clean needles and naloxone, the antidote to an opioid overdose.

The center on Colfax Avenue, across from the state Capitol, collects about 3,500 used syringes each morning — a total of 16,848 in the last week. In a two-week stretch in January, seven of the center’s clients died, six from overdose and one from an aneurysm related to shooting drugs into the lower extremities.

That’s when Raville told her board of directors it was time to push for a supervised injection site. “It’s time,” Raville said. “We’ve lost too many people.”

She wants to put the supervised injection site inside her center, where the neighbors include the Colorado Department of Education, the Capitol and a Vietnamese pho restaurant. But the ultimate location is likely to be a point of intense discussion among public officials.

Looking for safe space

In a storage room at the center — an area potentially large enough to fit a supervised injection site — five clients who inject methamphetamine and heroin, including Torpacka, described sneaking around Denver looking for a safe place to get high.

Hurried and scared, they worry about not properly boiling the drug before injecting it. They worry about injecting it into a muscle instead of a vein, causing an abscess. They worry about not having clean skin and getting a skin infection.

They worry about children seeing them do it even when they are hiding their lighters under their coats, and they worry about looking nonchalant as they walk past management to use public bathrooms. Most of all, they worry about dropping dead in an alley, only to be discovered by a kid taking out the trash.

“We’re people too. We care what people think,” said Xavier, a 25-year-old couch-surfer. He did not want his last name published. “Imagine if we could do this someplace safe and we wouldn’t have to be in Civic Center park embarrassing the (expletive) out of ourselves?”

“If I die in the alley behind the trash can, how do I have a chance to improve my life?” asked Vernon Lewis. He said he would use a supervised injection site because it would be safer than using heroin alone in his apartment. “It’s terrifying,” he said of the risk.

Besides the likelihood of reducing drug use in public places, supervised injection sites also could serve as a first step in a user’s recovery, advocates and physicians say. Similar to a needle exchange, staffers would offer information on treatment when people came in to use drugs.

Dr. Steve Sherick, an emergency department physician and chair of the Denver Medical Society board, says he has treated “thousands” of opioid-addicted patients. And they are living “hour by hour.”

For them, he said, injecting drugs in a safe zone — where staff members are on hand to make sure they don’t die — is perhaps a step closer to thinking “week by week.”

The Denver Medical Society and the Colorado Medical Society are in favor of opening an injection site as part of a “comprehensive strategy” to fight the opioid epidemic.

“People are dying already,” Sherick said. “Shaming them clearly does not stop them from being addicted to drugs. What I want to do, from a doctor’s standpoint, is to try to stop people from dying.”

Shooting up at library

At this point, the Denver Public Library’s central location downtown has become a de-facto city injection site, albeit unsanctioned — and without the safeguards of a dedicated facility.

The problem is so rampant that library employees are trained to use naloxone on injection-drug users they find unconscious in the bathrooms. Other popular spots to inject include a downtown bus depot, bathrooms in Union Station and various homeless camps.

“This is a trial,” Sherick said of a potential safe injection site. “Let’s try it. If it doesn’t work, we can close it.”

But opening a site in Denver wouldn’t be as simple as a legislative vote. For one thing, while the city health department has been exploring the issue, Mayor Michael Hancock’s administration is not ready to endorse the idea.

Nationally, a handful of cities and states have looked at the possibility of opening injection sites, while federal officials have offered only a long-standing federal prohibition against maintaining premises for the purpose of using a controlled substance. Last week, a commission convened by President Donald Trump notably left out of its recommendations any support for sanctioning supervised injection sites.

That hasn’t stopped some places from trying — most prominently Seattle, which has put in a bid to be the first in the United States.

In January, Seattle’s mayor and the executive of King County announced they would support opening two injection sites, one in the city and one elsewhere in the county. But it has been a struggle. City after city, including several with prevalent opioid abuse, has passed an ordinance preemptively banning injection sites.

Elsewhere, California, Maryland and Maine are among states that have considered legislation in the last year to allow cities to set up injection sites, according to the National Conference of State Legislatures. But those efforts have failed in the face of opposition from legislators concerned about violating federal drug laws or sending the wrong message by, in their eyes, sanctioning illicit drug use.

Spikes in disease

Until their states’ legislators act, cities such as San Francisco and Baltimore may have little legal cover to open safe injection sites — although that hasn’t stopped San Francisco’s leaders from pressing forward.

Dr. Robert Valuck, who coordinates the Colorado Consortium for Prescription Drug Abuse Prevention, says he doesn’t expect that a pilot site in Denver would draw scrutiny from federal law enforcement officials.

“Right now, people are injecting in libraries, public buildings, business bathrooms, parkways, public spaces. People are injecting. Period,” he said, noting that spikes in HIV and hepatitis probably are due to sharing needles. “So we really need to figure this out.”

Brooks, the council president, says he will be joined on his trip to the Canadian clinic by an assistant city attorney and by his office staff. Besides visiting InSite, they planned to meet with Vancouver’s mayor, police chief and a City Council member.

Despite the recent push, Brooks has no illusion that an injection site will open anytime soon in Denver. He still has questions about how one would operate, he said — and he sees a treatment component as necessary “for it to be palatable in Denver.”

The idea faces uncertainty that includes not only the federal prohibition but effective bans on such a center at both the state and local levels that would need to be repealed.

Brooks has worked with state Rep. Leslie Herod, a Denver Democrat, on the issue but says he is most encouraged lately by the involvement of another lawmaker who has stepped up as a sponsor for the state bill: Sen. Kent Lambert, R-Colorado Springs.

“We’re still a long way from it,” Brooks said, “but the fact that Republicans are coming on board is huge. And I hate to give credit, but President Trump” — by declaring opioid abuse a public health emergency in late October — “I think that was really good, and it helped Republicans see that this is a really big issue.”

“I went through one of the largest surgeries — opened up twice in three weeks,” Brooks said. “And I had to take a lot of medicine, and I had to wean myself off of it. It was a big issue. And I just realized that a lot of people without the same support network and privilege that I have would end up in a really bad situation.”

He wasn’t addicted to the OxyContin, he said, but he felt the drug’s hooks in him. It took about a month of gradually reducing the dosage to stop. “What’s accurate is that I went through a state of withdrawals on it,” he said.

In the next couple months, Brooks and Herod will hold a series of community meetings to educate the public on safe-injection facilities and to gauge concerns. The first is set for 5:30 p.m. Nov. 30 at United Way, 711 Park Avenue West.

Jon Murray is an enterprise reporter on The Denver Post's government and politics team, with a focus on transportation. He previously covered Denver Mayor Michael Hancock and city government. A Colorado native, he joined The Denver Post in 2014 after reporting on city government and the legal system for The Indianapolis Star.

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